The best question to get patient rounding off to a great start

by Burl Stamp

While the health care executives we work with universally agree on the benefits of leader rounding conversations with both patients and staff, theories vary widely on how to make these interactions most helpful and productive.

Effectively choreographing these conversations depends much more on active listening to empathetically judge where to take the discussion than on inane scripts or lists of questions. A warm, sincere introduction and the right initial open-ended question can make or break the quality of the remainder of the encounter.

One of the best initial questions I’ve ever heard came from a recent conversation with Peggy Frizzell, the director of patient experience for Mary Immaculate Hospital in Newport News, VA. Peggy said that to open the conversation and really get to know the individual, she asks,

If you weren’t here in this hospital bed today, what would you be doing?”

I love the power, compassion and respect in this seemingly simple question. Peggy said it immediately lets the patient tell you about what he/she loves most – family, hobbies, sports, career or anything else that they personally deem important. And that opens the door to more trust, candor and transparency regarding how they really feel about their patient experience.

Inherent in this compassionate approach are several key ideas summarized below. These conversation characteristics provide a great litmus test for evaluating your approach to rounding on patients – and the staff who are taking care of them.

Person first, patient second

No one wants to be a patient. Individuals have to become patients because of their diagnosis or injury. In our focus group research, former patients consistently tell us that the best caregivers are able to see them as unique human beings with specific needs, wants, concerns and hopes before they see their diagnosis. At a basic level, we know not to refer to patients as the “the diabetic in room 222,” but our actions, underlying attitudes, and how we communicate with them have to align with that philosophy.

“How are you doing?” not “How are we doing?”

After keynoting a Quality Workshop/Retreat for Universal Health several years ago, I had the privilege of hearing presentations from hospital leadership teams about initiatives they were pursuing around various aspects of quality. I’ve always remembered how the team that had totally transformed the effectiveness of their leadership rounding on patients described their approach.

“When we started asking how they’re doing, not how we’re doing, our conversation changed completely,” they explained. Formerly armed with a list of questions to make rounding more “purposeful,” patients were reluctant to open up to executives when asked whether their nurse was in the room at least once per hour or whether the room was clean before any trust or rapport had been established.

A conversation, not an interrogation

Research confirms that patients are more reluctant to be open and forthright about concerns they have while they are still in our care. Not wanting to get their caregivers in trouble or risk any type of requital, patients find pointed questions to evaluate caregivers’ performance intimidating.

Much better are questions that are open-ended invitations to share what has gone well … and what could be better. Sometime that latter takes a bit of encouragement and reassurance: “I know you said everything is going fine, but if you could change just one thing about how we are taking care of you that would make it even better, what would that be?”

Leader conversations with patients offer a golden opportunity to stay connected to the most important, fundamental work in a health care organization. Establishing trust and focusing on the person in the bed first as a fellow human being will make these conversations more enlightening and satisfying for both the patient and leader.